Breast cancer history does not increase risk for colorectal cancer

In an effort to understand conflicting information about whether breast cancer makes colorectal cancer more likely, researchers at the University of Pennsylvania reviewed information from a large group of women with breast cancer and compared their rates of colorectal cancer to women without a history of breast cancer.

Using a research database from the United Kingdom that included 17,415 women with a history of breast cancer and 69,660 women without breast cancer, the research team calculated the risk for a subsequent colorectal cancer. The relative rate for colorectal cancer among those with breast cancer was 0.80.

The team concluded

Women with a prior diagnosis of breast cancer are not at an increased risk of colorectal cancer; these women can follow average risk screening guidelines for colorectal cancer.

Their results were reported in the [October 2005 issue of the *American Journal of Gastoenterology*](http://www.amjgastro.com/showContent.asp?DID=4&SessionGUID=B97EAA8F-8AE5-4F62-B825-A7AAC2731B33&id=ajg_316102005&type=abstract)

An [article in *The Lancet*](http://www.thelancet.com/journals/lancet/article/PIIS0140673600041970/abstract) in 2001 found a slightly reduced risk for colon and rectal cancer after breast cancer, compared to what was expected in the overall population. Women with breast cancer were 5% less likely to develop colon cancer and 13% less likely to be diagnosed with rectal cancer. Reduced risk was greatest in women whose breast cancer was diagnosed over age 65, in white women, and in women with local stage cancers.

Despite these results in the overall population a [2003 study](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12825849&query_hl=1) found that certain subgroups of breast cancer survivors had an increased risk to develop colorectal cancer. That included women with

+ a family history of breast cancer
+ high body mass index (BMI) over 30 mg/m²
+ lobular rather than ductal cancer

Most women with breast cancer probably can follow colorectal screening guidelines for people of average risk but should discuss their individual risk factors with their doctors.

Posted by Kate Murphy on October 16th, 2005
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Combination of trimetrexate and capecitabine for previously treated metastatic colorectal cancer

Researchers at the University of Pittsburgh tested the combination of trimetrexate (TMTX) and capecitabine (Xeloda™) in patients with metastatic colorectal cancer whose disease had already gotten worse with previous treatments. All patients had received 5FU (flourouracil) and 94% had received irinotecan (Camptosar™). This was the second or third treatment regimen for all patients in the study.

Although the combination showed some effectiveness and was tolerated by patients, there were other current treatments that were more active, the research team concluded.

In the phase I part of the study, they were able to determine a tolerable dose of 100 mg/m² and 1000 mg/m² of capecitabine. Serious side effects included abdominal pain in 12.5% of patients and vomiting in 9.4.%.

Twenty-seven patients were included in evaluation of effectiveness. One patient had a complete response, another a partial response to the combination for an overall response rate of 7.7%. The median time until the cancer progressed was 3.3 months and the median overall survival time was 5.5 months.

Khalid Matin M.D. led the research team who concluded,

The combination of TMTX and CAP is well tolerated. However, recent studies have shown more active regimens in the second- and third-line metastatic setting.

[Read the study abstract in the October 2005 *American Journal of Clinical Oncology*](http://www.amjclinicaloncology.com/pt/re/ajco/abstract.00000421-200510000-00002.htm;jsessionid=DRiuNuvn4zz9M04ZmT6mCxWyaXmmGcTVfGHCcwJk2is2iVRHDQFv!-1202648512!-949856145!9001!-1)

Posted by Kate Murphy on October 15th, 2005
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NCI Teleconference: Why Statistics Matter for Advocates

NCI is offering a teleconference *Why Statistics Matter for Advocates*. This follows up a conference held in April of 2005. The teleconference is free and available on a toll-free line. Playbacks are also possible for a month after the teleconference.

+ *Why Statistics Matter for Advocates: Follow Up from the April, 2005 SEER Advocacy Conference*
featuring Dr. Brenda Edwards, Associate Director, NCI Surveillance Research Program

+ Wednesday, October 19, 2005 at 2:30 p.m. (EST)

+ USA Toll-Free: 1-800-857-6584 Passcode: 4683#

+ Toll-Free Playback: 1-800-229-6227 until Nov. 19, 2005 at 10:30 p.m. (EST)

Toll-free playbacks of the first in this series of teleconferences *Eliminating Suffering and Death Due to Cancer by 2015: The Future of Cancer Research* featuring Dr. Andrew C. von Eschenbach, Director, National Cancer Institute is available until October 20, 2005.

Toll-Free Playback: 1-866-443-2931 until Oct. 20, 2005 at 5:30 p.m. (EST)

Posted by Kate Murphy on October 13th, 2005
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Age and gender do not make a difference in how soon to repeat colonoscopy after removing a suspicious polyp

Neoplastic polyps either are already malignant or have the potential to become cancerous over time. When a non-malignant neoplastic polyp is discovered and removed during colonoscopy, a follow-up colonoscopy is scheduled to watch for additional polyps. Current [guidelines](http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=3686&nbr=2912&string=)
call for follow-up colonoscopy after 3 - 5 years unless there is unusual risk.

Researchers were concerned that age or gender might make a difference in how often such follow-up should be scheduled. They reviewed the information in a database of 1800 patients who had two colonoscopies where a neoplastic polyp was removed during the first one.

They found that 19% of patients had at least one new polyp bigger than 5 millimeters on the second colonoscopy. Six percent had a polyp larger than 10 millimeters. However, there was no difference in the overall risk of polyps recurring in any age group or gender.

They wrote in the November/December 2005 issue of the *Journal of Clinical Gastroenterology* — 39(10):894-899:

Conclusions: Similar rates of neoplasia recurrence were observed among patients of different gender and age groups on surveillance colonoscopy. From a health resource utilization perspective, these findings support current recommendations for similar surveillance intervals for patients regardless of age and gender.

It is important to note that last year a survey published in the [Annals of Internal Medicine](http://www.annals.org/cgi/content/summary/141/4/264) found that half of gastroenterologists and from 50 to 80 percent of general surgeons would perform colonoscopy more frequently than the guidelines call for. The authors of the study asked, *”Are physicians doing too much colonoscopy?”*

[Read the abstract of the article in the *Journal Clinical Oncology*.](http://www.jcge.com/pt/re/jclngastro/abstract.00004836-200511000-00009.htm;jsessionid=DLd1Nrh6yh1i2eU2xQ51sqtxG5Fr0DTluBn0U5Q37sStEni3zbXX!-1774793403!-949856145!9001!-1)

Posted by Kate Murphy on October 10th, 2005
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Radiotherapy before surgery for rectal cancer increases sexual problems in men

Radiation therapy given before surgery to remove rectal cancer can reduce the risk that the cancer will return at the site of the original tumor. In some cases it can shrink tumors significantly allowing for surgery that spares the sphincter muscle closing the anus and avoiding a permanent colostomy.

However, research in the [October 2005 *Annals of Surgery*](http://www.annalsofsurgery.com/pt/re/annos/toc.00000658-200510000-00000.htm;jsessionid=DLXGyCyb1Tc8BDtrfGDR254EBG0zJn5b48F6zJPWzjOts8wwT9il!586698740!-949856144!9001!-1) found that radiotherapy results in more sexual problems in men than surgery alone.

Surgeons studied the difference between surgery alone and surgery with pre-operative radiotherapy in 201 men being treated for rectal cancer. They assessed the ability to achieve and maintain an erection, have an orgasm, and be sexually active at 7 time points, beginning before surgery and ending 4 years later.

The most severe dysfunction was found 8 months after surgery when there was a 7.4% difference in achieving an erection, 12.6% difference in maintaining one, and a 16.2% difference in having orgasm between the radiotherapy and surgery only groups. In addition, men who had radiotherapy were 13.7% less likely to be sexually active. Recovery of sexual functioning after the 8 month point was slow, but never returned completely.

The effect increased with age.

The researchers were able to build and validate a model to help patients and doctors predict how much radiotherapy might effect the sexuality of an individual man.

The research and the predictive model were reported in the *Annals of Surgery* (240-4:502-511, October 2005). The lead author was Alexander G. Heriot. The team concluded:

Conclusions: Radiotherapy has an adverse effect on sexual function, the effect being maximal at 8 months after surgery. The risk of sexual dysfunction can be quantified preoperatively using the proposed index and can assist patients in making better informed choices on the type of treatment they receive.

In [a Dutch study in the March 20, 2005 edition of the *Journal of Clinical Oncology*](http://www.jco.org/cgi/content/abstract/23/25/6199), 900 men and women, who were part of a randomized trial surgery alone or surgery and radiotherapy, also showed poorer sexual functioning in males. Females also had sexual problems after pre-surgical radiotherapy.

In addition, radiation-treated patients recovered normal bowel movements more slowly and were less active 3 months after surgery than those who had surgery alone.

However, the patients reported no significant differences in health-related quality of life on questionnaires answered before treatment and at 3, 6, 12, 18, and 23 months after treatment.

Since there is a way of predicting the risk of sexual problems after radiation treatment for rectal cancer developed by Dr. Heriot’s team, patients should be encouraged to discuss risks and benefits of radiation prior to surgery.

[Read the abstract of the Heriot study in the *Annals of Surgery*.](http://www.annalsofsurgery.com/pt/re/annos/abstract.00000658-200510000-00005.htm;jsessionid=DLXGyCyb1Tc8BDtrfGDR254EBG0zJn5b48F6zJPWzjOts8wwT9il!586698740!-949856144!9001!-1)

[Read the Marijnen study abstract in the *Journal of Clinical Oncology.*](http://www.jco.org/cgi/content/abstract/23/9/1847)

Posted by Kate Murphy on October 10th, 2005
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